Active NPI
Heavenly Vision
- Optician
- Bangor, PA
National Provider Identifier
1104373265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 046078
- Legal business name
- HEAVENLY VISION
- Practice address
- 455 Blue Valley Dr
Bangor, PA 18013 - Phone
- (610) 432-7000
- NPI assigned
- Sep 7, 2016
- Organization subpart
- Yes
- Parent organization
- BLUE VALLEY VISION LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Timothy James Velekei Sr., OPTICIAN
- Title
- Optician / Owner
- Phone
- (610) 432-7000
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 046078 | PA | Primary |
Addresses
Primary practice location
455 Blue Valley Dr
Bangor, PA 18013
Mailing address
455 Blue Valley Dr
Bangor, PA 18013-1513
Phone (610) 432-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13658572 | Other | PA | CAQH |
Other names 1
- Blue Valley Vision
National Provider Directory
National Provider Directory- Tax ID family
- Blue Valley Vision LLC
- Part of
- Blue Valley Vision LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Eyewear Supplier
- Bangor, PA
- NPI 1104298140
Locations
455 Blue Valley Dr
Bangor, PA 18013
Phone (610) 432-7000
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optician
- Bangor, PA
- NPI 1881059293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1473206400000",
"number": "1104373265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 BLUE VALLEY DR",
"city": "BANGOR",
"state": "PA",
"postal_code": "180131513",
"telephone_number": "610-432-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 BLUE VALLEY DR",
"city": "BANGOR",
"state": "PA",
"postal_code": "18013",
"telephone_number": "610-432-7000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEAVENLY VISION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BLUE VALLEY VISION LLC",
"enumeration_date": "2016-09-07",
"last_updated": "2016-09-07",
"status": "A",
"authorized_official_last_name": "VELEKEI",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "OPTICIAN / OWNER",
"authorized_official_telephone_number": "610-432-7000",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "OPTICIAN"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Technician/Technologist, Optician",
"state": "PA",
"license": "046078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13658572",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Blue Valley Vision",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bangor, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.